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网络服务 会员支付 自付额 每人 $400 $500 $800 $800 $900 $1,600 $1,200 $1,300 $2,400 $1,600 $1,700 $3,200 每个家庭最高自付额 $1,500 $1,500 $2,400 $2,700 $2,700 $4,800 $3,900 $3,900 $7,200 $5,100 $5,100 $9,600 每人最高自付费用 (OOP) 3 $2,850 $3,250 $6,000 $3,850 $4,250 $8,000 $4,850 $5,250 $10,000 $6,700 $7,100 $13,700 自付费用（OOP）每个家庭最高限额 3 $9,750 $9,750 $18,000 $12,750 $12,750 $24,000 $15,750 $15,750 $27,400 $15,800 $15,800 $27,400 预防保健服务常规成人、儿童和妇女检查；年度肥胖筛查和免疫接种 $0 1 $0 1 扣除免赔额后 50% $0 1 $0 1 扣除免赔额后 50% $0 1 $0 1 扣除免赔额后 50% $0 1 $0 1 扣除免赔额后 50% 门诊就诊和虚拟护理 初级保健门诊就诊 $20 1,5 扣除免赔额后 20% 扣除免赔额后 50% $20 1,5 扣除免赔额后 20% 扣除免赔额后 50% $25 1,5 扣除免赔额后 25% 扣除免赔额后 50% $25 1,5 扣除免赔额后 25% 扣除免赔额后 50% 初级保健门诊就诊，由您选择的 PCP 360 以外的医疗服务提供者进行（仅限 Moda 计划） $40 1 N/A 扣除免赔额后 50% $40 1 N/A 扣除免赔额后 50% $50 1 N/A 扣除免赔额后 50%免赔额
MSC 3707 OEBB 福利摘要 2023-24 计划年度
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